Trials and Tribulations of Protecting Children from Environmental Hazards
Lanphear, Bruce P., Paulson, Jerome, Beirne, Sandra, Environmental Health Perspectives
Society is increasingly aware of the profound impact that the environment has on children's health. Not surprisingly, there is increasing public scrutiny about children's exposures to environmental hazards, especially for disadvantaged children. These trends underscore the ethical imperative to develop a framework to protect children from environmental hazards. Such a framework must include regulations to test new chemicals and other potential hazards before they are marketed, a strategy to conduct research necessary to protect children from persistent hazards that are widely dispersed in their environment, stronger regulatory mechanisms to eliminate human exposures to recognized or suspected toxicants, and guidelines about the ethical conduct of research and the role of experimental trials that test the efficacy and safety of interventions to prevent or ameliorate children's exposure to persistent toxicants or hazards that are widely dispersed in their environment. Key words: assent, children, consent, controls, environmental exposure, ethics, health, prevention, policy, research.
Protecting children from environmental hazards is a daunting task. Environmental toxicants, such as lead, methylmercury, tobacco, and other pollutants covertly enter children's body via placental transfer during fetal growth, inhalation or ingestion of house dust, soil, breast milk, and other dietary sources during early childhood (Landrigan et al. 1998; Perera et al. 2003). Exposures to these toxicants have been linked with the new "morbidities" of childhood--intellectual impairments, behavioral problems, asthma, and preterm birth (Lanphear et al. 2005b). These and innumerable other environmental chemicals can regularly be detected in young children and women of reproductive age [Centers for Disease Control and Prevention (CDC) 2005]. Respiratory toxicants are so commonplace that we accept as inevitable that over 4 million U.S. children will develop asthma (Akinbami And Schoendorf 2002)--many through exposure to airborne pollutants (Gauderman et al. 2004; Gent et al. 2003; McConnell et al. 2002). Despite a profound attachment to our own children and intense rhetoric about the value of children, society has been unwilling to invest the resources or develop regulations that are necessary to protect children from environmental hazards.
A new framework to protect children from environmental hazards is an ethical imperative. Given the increasing evidence linking children's exposures to environmental hazards with adverse health consequences, a framework to protect children from environment hazards must include regulations to test new chemicals and other potential hazards before they are marketed. It must include a strategy to conduct research necessary to protect children from persistent hazards that are widely dispersed in their environment. It must provide a regulatory mechanism to implement policy that will eliminate human exposures to recognized and suspected toxicants. Finally, it must contain guidelines about the ethical conduct of research and the role of experimental trials that test the efficacy and safety of interventions to prevent or ameliorate children's exposure to persistent toxicants.
Protecting Children from Toxicants
Regulations to protect children from environmental chemicals are evolving. In the 1960s, following the epidemic of phocomelia from thalidomide, regulations were developed to protect pregnant women from exposure to teratogenic drugs--drugs that induce either structural or functional abnormalities (Hilts 2003). These regulations require premarket testing to ensure the safety and efficacy of pharmacologic agents.
Since then, it has become increasingly clear that pregnant women are often inadvertently exposed to numerous environmental teratogens (CDC 2005). Fetal and early childhood exposures to environmental toxicants, such as lead, methylmercury, polychlorinated biphenyls, and tobacco smoke, have been associated with an increased risk for premature birth, spontaneous abortions, delinquency and conduct disorder, intellectual deficits or attention deficit hyperactivity disorder (Baghurst et al. …